The western black-legged tick, carrier of the Borrelia burgdorferi bacteria which causes Lyme disease.

The practice of infectious disease (ID) is both easy and difficult. If you read my ID blog on Medscape you are aware of my trials and tribulations in diagnosing and treating infections.

ID is easy since, at least in theory, diseases have patterns and an infecting organism has a predictable epidemiology and life cycle. So if you can recognize the pattern and relate it to the life cycle and exposure history, you can often make a diagnosis before the cultures come back.

My favorite story is the time I was asked to see a young girl with endocarditis. The history was she had a week of fevers, headache and myalgia that went away for five days, returned for a week, went away for five days and returned yet again.

So I asked her “How was your vacation at Black Butte?”

The look of astonishment on her face as she asked how I knew she had been to Black Butte was so satisfying. (more…)

Editors’ note: With this guest post, we welcome Britt Marie Hermes to the SBM blog. Her new blog NaturopathicDiaries.com was mentioned by Jann Bellamy last week. Hermes is a former naturopath who came to doubt naturopathy. Through her contact with Jann, she has agreed to contribute occasional blog posts to us. Her insights into the pseudoscientific medical system of naturopathy, her reasons for becoming a naturopath, her reasons for leaving naturopathy, and, most importantly, her inside knowledge of naturopathy, will provide compelling reading. Here is the first of what, we hope, are multiple posts.

In 2011, I graduated from Bastyr University with a doctorate in naturopathic medicine. I passed the Naturopathic Physicians Licensing Examination (NPLEX) and landed a competitive, one-year residency in family medicine and pediatrics at an out-patient clinic in Seattle. When I completed my residency, I remained at this clinic for a brief time before moving to Arizona to practice until 2014.

During my time in Arizona, I realized that my profession had severely misled me. Naturopathic medicine is marketed as a “distinct form of primary health care.” This phrase is ubiquitous: it appears on the websites of naturopathic medical schools, on materials published by practicing naturopaths, and on lobbying documents to promote the unfettered licensure of naturopaths and to expand eligibility for federal loan repayment programs. Based on my educational and professional experience as an accomplished member of the naturopathic community, I can say that naturopathic medicine might be a distinct form of something, but it is not any form of primary health care. I am saddened to report that not only was I misled, but so were hundreds of legislators, thousands of students, and tens of thousands of patients.

Historical image of a patient undergoing hydrotherapy treatment. Image from the History of Medicine (NLM).

Given my journey through naturopathic medical school, I can provide strong evidence and testimony of the quality and quantity of training at Bastyr University. I base what follows on my academic transcript, course syllabi, course catalog, and the student clinician’s handbook in addition to my personal experiences. It should come as no surprise to readers of ScienceBasedMedicine.org that naturopathic training is not as the profession presents. I’ll say it anyway: naturopathic education is riddled with pseudoscience, debunked medical theories, and experimental medical practices.

Britt Marie Deegan Hermes had a bad experience with a medical doctor, which piqued her interest in naturopathy. Eventually, she graduated from Bastyr University with an N.D. degree and practiced as a naturopath for about 3 years. But her confidence in naturopathy withered as she watched fellow naturopaths practice in Tucson, Arizona. Her disenchantment with naturopathy drove her back to medicine and science. Britt left naturopathic practice behind and is now a student in the Medical Life Sciences program at the University of Kiel, in Germany, a Master’s of Science program focusing on biomedical research. Britt is not turning her back on those who suffer from what she calls the “blatantly false, unethical, and dangerous practices” she saw during her time as a naturopath. Nor is she willing to remain silent while other idealistic young people are drawn into studying what she describes as

a system of indoctrination based on discredited ideas about health and medicine, full of anti-science rhetoric and ineffective and sometimes dangerous practices.

David Gorski, Orac, and the Canadian media, especially the Canadian Broadcasting Corporation (CBC), have done an excellent job of chronicling the activities of “Dr.” Clement. All have reported on Florida’s taking action against Clement. I’ll give a brief background here, most of which comes from Dr. Gorski’s most recent post, as well as add some information and observations to theirs.

Hippocrates Health Institute, located in West Palm Beach, Florida, is licensed as a massage establishment by the state and run by Brian Clement and his wife, Anna Maria Gahns-Clement. Clement and Hippocrates came to the attention of the Canadian media when, last year, the families of two Canadian aboriginal girls withdrew their children from conventional cancer treatment, including chemotherapy. Prior to that, Clement had basked in the glory of fawning reports from local media, one of which described him as having an “inimitable, engaging style.” Another described him as coming “fresh from a detoxifying sauna” to the interview.

Had they completed conventional treatment, both girls had a very good chance of survival. The families opted instead for traditional medicine as well as “alternative medicine” at Hippocrates. Each paid a reported $18,000 for participation in a “Life Transformation Program” there. This included, for at least one of the girls, cold laser therapy, vitamin C injections and a strict raw vegetable diet.

Today’s post is a reluctant challenge. I’m nominating my own alma mater, the University of Toronto, as the new pseudoscience leader among large universities – not just in Canada, but all of North America. If you can identify a large university promoting or embracing more scientifically questionable activities, I’ll happily buy you a coffee. Yes, it’s personal to me, as I have two degrees from U of T. But I’m more concerned about the precedent. If Canada’s largest university is making decisions that appear to lack a careful consideration of the scientific evidence, then what does that suggest about the scientific standards for universities in Canada? (more…)

Back in 2004, data from the 2002 National Health Interview Survey (NHIS) appeared in a report titled “Complementary and Alternative Medicine Use Among Adults: United States, 2002.” It showed a whopping 62% of adults had used CAM in the past 12 months, but only if prayer for health reasons was included. With prayer excluded, the percentage was substantially lower, at 35%.

“CAM” was defined as:

a group of diverse medical and health care systems, therapies, and products that are not presently considered to be part of conventional medicine.

The authors noted that, in earlier surveys of CAM use, “CAM has been operationally defined in a variety of ways” and the lists of CAM interventions/therapies included “varied considerably among the surveys.”

The most commonly used CAM therapies (excluding prayer) were non-vitamin, non-mineral natural products (18.9%), deep breathing exercises (11.6%), chiropractic care (7.5%), yoga (5.1%), massage (5.0%) and diet-based therapies (3.5%). CAM was most often used to treat back pain or problems, head or chest colds, neck pain or problems, joint pain or stiffness, and anxiety or depression. Most CAM use was self-prescribed. Rebranding things like exercise (yoga) as “CAM” was in the mix from the get-go.

The FDA regulates in vitro diagnostic devices (IVDs) as medical devices. IVDs analyze human samples, such as blood, saliva, tissue and urine. However, in the past, the agency did not use its authority to regulate what are known as “laboratory-developed tests” (LDTs), tests developed and performed at a single laboratory, with all samples sent to that particular lab for testing. Instead, it focused on commercial tests kits, which are broadly marketed to laboratories or the public. These tests had to undergo the same pre-market approval process as other medical devices regulated by the FDA, including, in some cases, clinical studies demonstrating that the device is safe and effective for its intended use.

Historically, LDTs were developed by hospitals, researchers and academic medical centers for their own use. That is no longer true. In the past 15 years or so, there has been an explosion in the use of LDTs by commercial labs and biotechnology companies. The FDA now estimates that there are about 11,000 LDTs offered by 2,000 laboratories. One estimate is that the results of clinical lab tests (although not exclusively LDTs) influence 70% of health care decisions. (See the Congressional Research Service Report’s exhaustive analysis of FDA regulation of IVDs and inclusion of LDTs for more on the history and current use of LDTs.)

Do you have any idea whether the IVDs that have poked around in your blood or tissues are FDA-approved or unapproved LDTs? (Does your physician?) Do you know what evidence (if any) there is standing behind these tests? No? Me either. That’s because there is no requirement that anyone give you this information. (more…)

I am happy to report some good news: chiropractors, naturopaths, acupuncturists and assorted other practitioners of pseudo-medicine didn’t fare too well in the 2013-2014 state legislative sessions.

We’ve been following their legislative efforts all year over at the Society for Science-Based Medicine. Some state legislatures meet in yearly sessions. At the end of the year, pending bills die with the session. Some meet only every other year. Others meet in two-year sessions and, in some of these, legislation introduced in one year carries over to the next year. All states with two-year sessions ended these sessions at the close of 2014, except New Jersey and Virginia. If you want to see how your state operates, several websites can help you: MultiState Associates, National Conference of State Legislatures and StateScape.

Chiropractors

Chiropractors are already licensed in all 50 states and all of their practice acts permit the detection and correction of the non-existent subluxation. Having achieved that goal, the focus of chiropractic legislative efforts is to expand their scope of practice (the holy grail, for some, being primary care physician status), turf protection and mandates requiring insurance reimbursement or their inclusion in various activities, such as sports physicals, concussion treatment, and scoliosis detection programs.

The most interesting chiropractic bill, one from Oklahoma, didn’t fall into any of those categories:

Chiropractic physicians in this state shall obtain informed, written consent from a patient prior to performing any procedure that involves treatment of the patient’s cervical spine and such informed consent shall include the risks and possible side effects of such treatment including the risk of chiropractic stroke.

Happy New Year! Today’s post was some old material, dusted off, repackaged, and updated for 2015.

New Year, New You, right? We’re just into 2015, and you’ve resolved to finally get serious about your health. Starting today. But first need to cleanse yourself, eliminating last year’s lifestyle and dietary sins. You’ve seen the ads and the Facebook links, all suggesting you need a “detox”, “cleanse” or “flush” to be healthy. Supplements, tea, homeopathy, coffee enemas, ear candles, and footbaths promise you a detoxified body. Amazon has entire detox and cleansing categories in supplements and books. The descriptions all suggest detoxing will deliver a renewed body and better health – it’s only seven days and $49.95 away. Dr. Oz has several detox plans – you just need to decide which one. The local naturopath sells detoxification protocols, including vitamin drips and chelation. Even your pharmacy probably has a wall of products for sale. Wouldn’t a purification from your sins of 2014 be a good idea to start the year? Unfortunately, there’s something very important that detox promoters aren’t telling you. (more…)